Thyroidectomy surgery

Your thyroid gland sits within the front part of your neck and produces thyroid hormones that control your metabolism. 

There are 2 types of thyroidectomy:

• A partial thyroidectomy (subtotal thyroidectomy) — part of the thyroid gland is removed
• A full thyroidectomy (total thyroidectomy) — the entire thyroid gland is removed 

Signs of needing thyroidectomy surgery 

You may need thyroidectomy surgery if you have a thyroid condition that cannot be effectively controlled with other treatments.

Thyroid conditions that may need surgery include:

• Goiter — non-cancerous growth or swelling of the thyroid gland
• Graves' disease — an autoimmune condition that increases the activity of the thyroid gland
• Thyroid cancer
• Thyroid nodules — lumps in your thyroid gland that may or may not be cancer; if testing the lump doesn’t provide a clear answer on whether it’s cancerous or not, your doctor may recommend surgery 

These conditions often cause the thyroid gland to become overactive, causing excessively high levels of thyroid hormones in your body. This is called hyperthyroidism. 

Signs of hyperthyroidism include: 

• Diarrhoea
• Difficulty sleeping
• Fatigue
• Muscle weakness
• More frequent urination and increased thirst
• Reduced interest in sex
• Sensitivity to heat and itchy skin 

You may be prone to mood swings and become more anxious, irritable and nervous. 

Is thyroidectomy surgery right for you? 

Thyroidectomy is the main treatment for thyroid cancer alongside other treatments, such as radiotherapy, chemotherapy, radioactive iodine and targeted cancer drugs. 

For other thyroid conditions, a thyroidectomy is not the first option for treatment. Your doctor may recommend medications to bring your elevated thyroid levels back within a normal range. 

If medication is not effective and/or your enlarged thyroid is pressing against your windpipe (trachea) and making breathing difficult, your doctor may recommend surgery.

Alternative treatments to thyroidectomy surgery 

Thyroid cancer is usually treated with a thyroidectomy, but other thyroid conditions can be treated with non-surgical options including: 

• Ablation — thyroid nodules are removed via minimally invasive procedures using fine needles, such as ethanol ablation and radiofrequency ablation
• Medication — the drugs carbimazole and propylthiouracil reduce the amount of hormones produced by the thyroid gland
• Radioactive iodine — a single dose of radioactive iodine destroys some of the cells in the thyroid gland that produce hormones

Thyroidectomy surgery is usually performed under general anaesthesia, which means you will be asleep. A cut of around 6–8cm is made into the neck, taking care to avoid damaging nearby nerves and blood vessels, particularly the nerves that supply your voice box (larynx) and the blood vessels supplying your parathyroid glands. 

Part or all of the thyroid is removed, and a drain is inserted to help remove any excess blood that builds up after surgery. The cut is then stitched up.

You’ll be asked to complete a pre-admission questionnaire about your medical history and any support you may need at home after surgery. 

You may need to attend a pre-admission clinic for certain tests eg blood tests, X-ray, etc. You’ll be told how long to fast for before your surgery ie not eating or drinking anything other than water. 

On the day of your surgery, you’ll be asked to change into a hospital gown. 

Who will be involved? 

Your thyroidectomy will be performed by a surgeon who specialises in endocrine surgery. Your care team will include several nurses and an anaesthetist. 

How long does thyroidectomy surgery take? 

Thyroidectomy surgery usually takes 2–3 hours. As it’s usually performed under general anaesthetic, you’ll need to stay in hospital overnight. 

Managing pain during and after surgery

During surgery, you will be under a general anaesthetic, and you will have a long-acting analgesic (a drug that numbs tissue so you do not feel pain).

After surgery, you’ll be given regular oral painkillers in hospital and to take home.

What happens straight after surgery?

You’ll be taken to a recovery room where your vital signs will be monitored.

It takes around 24 hours for general anaesthesia to wear off. During this time, you may feel drowsy, dizzy and dazed.

After the operation 

In the first 24 hours, you’ll be in hospital and closely monitored. You should not drive, make any important decisions or operate machinery during this time. 

You’ll be asked to sit up when you can. This helps reduce swelling around the wound. Keep your head slightly raised during your first night of sleep after surgery. 

When back home, you can shower with soap as usual as your wound will be covered with a waterproof dressing. You should not bathe or swim for 2 weeks after surgery. 

Recovery time 

In most cases, you’ll need around 1 week off work. Avoid any heavy lifting or vigorous exercise for around 2 weeks. 

Short-term side effects 

In the first 24 hours after surgery, your calcium levels may drop. Signs include a tingling sensation in your fingers or around your mouth. If this occurs, you’ll be given supplements to restore your calcium levels. 

Your voice may sound different for a few days or weeks. Neck swelling is also normal for up to 2–3 weeks.

Numbness on the front of your neck is likely but will improve after a few weeks. 

Wound care 

The drain inserted into your neck will usually be removed while you’re in hospital. Your wound will be covered with a waterproof dressing, which can be removed after a week. Your stitches will dissolve over several weeks. 

Avoid submerging your wound site underwater for the first 2 weeks after surgery. 

Pain relief 

You will be prescribed over-the-counter painkillers when you’re discharged from hospital. Take these regularly for the first 48 hours and as needed afterwards.

Smoking 

Avoid smoking after surgery, particularly during the first 2 weeks. Smoking interferes with healing. 

Driving 

Don’t drive for the first 24 hours after surgery. Only return to driving when you can safely do so ie the effects of any painkillers no longer interfere with your ability to drive and you can physically perform all the necessary movements safely eg turning your head to look behind you.

Every surgery carries the risks of excessive bleeding, infection, blood clots and haematomas (swelling caused by a blood clot). These occur in a few cases in every 100.

General anaesthesia comes with the common risk (a few in every 10 cases) of feeling nauseous and dizzy, as well as vomiting and headaches.

Thyroidectomy surgery specifically comes with the risk of a drop in calcium levels. This occurs in a few cases in every 100 and is due to damage to the glands that sit next to the thyroid glands — the parathyroid glands. This is treated with calcium and vitamin D supplements and can be temporary or permanent.

You may develop a keloid scar after a thyroidectomy. While in most cases, thyroidectomy scars heal well, in a few cases in every 100, the scar may thicken. Keloid scars can be treated to improve their appearance.

In a few cases in every 1,000, thyroidectomy surgery can permanently damage the nerves that supply the larynx. This can cause a hoarse voice or change the quality of your voice.